Hospital seeks level playing field

Thursday

Jan 31, 2008 at 2:15 AM

An initial article and subsequent editorial on the subject of free-standing surgery centers continues to generate responses from those engaged with such enterprises. In the process, there are comments being made that might cause the reader to wonder what exactly is going on.

STEPHEN ABBOTT

An initial article and subsequent editorial on the subject of free-standing surgery centers continues to generate responses from those engaged with such enterprises. In the process, there are comments being made that might cause the reader to wonder what exactly is going on.

This is particularly true with the recent My View, titled "Why free market works for health care." Most health-care economists and anyone close to the delivery of health care understand that free market does not work in health care. If an individual goes to a department store with the intent of buying a shirt and does not have the money to buy such an item, he or she will walk out of the store empty handed. This is not the case in a hospital. A patient who enters the emergency room with a disease or injury will receive the needed treatment regardless of ability to pay. This is what separates us, a not-for-profit hospital, from a variety of for-profit enterprises in the health-care system.

Hospitals were established to provide essential community health care services and are expected to be there 24/7 whenever needed for whatever reason. We are expected to offer our community programs on the basis of community need not on financial gain, and at Cape Cod Healthcare, we endeavor to do just that. Over the years, the cost burdens that we bear have grown even greater.

Ten years ago, hospitals didn't pay physicians for taking emergency room call. It was considered a responsibility of being a member of the hospital's medical staff. Today, however, given the tremendous volume of care that goes through our emergency rooms, it seems fair that we try to offer certain physicians compensation for this additional responsibility.

It was also true, 10 or 15 years ago, that physicians would recruit their own replacements and grow their own practices. Given the lower reimbursements in Massachusetts, this is not happening to any great degree, particularly in the areas of primary care. Therefore, to provide access for our residents, we have and continue to recruit and employ primary care physicians now numbering approximately 40.

We have other costs that have no revenue to cover losses, such as our hospitalist program, psychiatric programs and generally being open and available 24/7 with an excellent and well-trained staff that stand ready to work with our physicians and provide excellent care to all we serve.

Another complicating reality for us is that we live in a community that is older than the rest of the state, and our source of payment for medical services largely comes from Medicare. As many may know, this is a fixed payment system where, regardless of our costs, we are only paid what the government chooses to pay us. Over the years, there has been a growth in outpatient centers delivering outpatient surgery, imaging and procedural offerings in urology and gastroenterology. Historically, we used those revenues to support programs for which there was inadequate reimbursement. With our revenues from traditional sources shrinking and our cost burdens growing, one can see the challenge we face.

What's been misleading is characterizing the bill sponsored by state Sen. Rob O'Leary as being uncompetitive or unfair to those operating surgery centers. The clear intent of this bill is not to provide uncompetitive barriers but simply subject them to the same requirements and regulations that the hospital must follow.

As was stated in the Cape Cod Times editorial of Jan. 12, "there is no reason procedures in an industrial park shouldn't be counted, scrutinized and evaluated for outcomes the same as a procedure in a hospital." In many ways, that sums up the intent of the bill, which is to:

1.) Subject new centers to the same planning guidelines that hospitals and other sectors of the health-care industry with something called a "determination of need;"

2.) Require oversight, such as certain reporting on quality outcomes, at these centers as is the case for surgical cases performed in hospitals;

3.) Require these centers to contribute fair share payments to support the care of the uninsured, just as hospitals must do.

Cape Cod Healthcare and its two hospitals, Falmouth Hospital and Cape Cod Hospital, continue to provide high quality surgical and other services as well as being there when people need services. We don't see these requirements to be barriers to entry for additional outpatient services or unreasonable given the concerns for patient safety. Hospitals are not asking for special treatment, just equal treatment.

I applaud Senator O'Leary for having the insight and big-picture point of view to recognize this as an important issue by trying to create a level playing field.